{"id":425,"date":"2017-11-20T15:29:03","date_gmt":"2017-11-20T15:29:03","guid":{"rendered":"http:\/\/www.medbenanalytics.com\/?p=425"},"modified":"2018-01-31T15:30:03","modified_gmt":"2018-01-31T15:30:03","slug":"outpatient-arthroplasty-provision-requires-team-strategy","status":"publish","type":"post","link":"http:\/\/www.medbenanalytics.com\/?p=425","title":{"rendered":"Outpatient Arthroplasty Provision Requires Team Strategy"},"content":{"rendered":"

The Medicare hospital outpatient prospective payment system (OPPS) final rule includes something that will have a direct bearing on the Bundled Payment for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) models:<\/span> a provision that removes total knee arthroplasty from the inpatient-only list beginning in January 2018<\/span><\/a>.<\/span><\/p>\n

The broadening of how Medicare will reimburse the procedure raises the question of how it will affect bundled payments – specifically, <\/span>whether or not<\/span> a potential shift of younger, healthier patients choosing the outpatient option will skew BPCI and CJR outcomes.<\/span><\/p>\n

In the final rule, the Centers for Medicare & Medicaid Services (CMS) stresses that while it does not expect a “significant volume” of total knee arthroplasty cases to switch to outpatient treatment, it will monitor the situation and <\/span>make adjustments<\/span> if necessary. But the bottom line is, no one knows for certain the effect the provision will have on model pricing.<\/span><\/p>\n

What we do know for sure is that the change will affect the decision-making that goes into which patients are better suited for outpatient treatment and which will best benefit from a longer hospital stay. Toward that goal, the smart strategy right now is for your administrative and clinical teams to evaluate the possible impact to reimbursement, pre-certification, and patient care and prepare accordingly, making process changes where necessary.<\/span><\/p>\n

When CMS finalizes the model changes, MedBen Analytics will offer further insights. In the meantime, if you wish to share your own thoughts about the OPPS outpatient arthroplasty provision, you can contact CMS no later than 5 p.m. EST on December 31, 2017. <\/span>Electronic comments<\/span><\/a> are preferred, but you can also submit your comments by regular mail, express\/overnight mail, or hand\/courier. <\/span>The OPPS rule<\/span><\/a> provides detailed submission instructions beginning on page 2.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

The Medicare hospital outpatient prospective payment system (OPPS) final rule includes something that will have a direct bearing on the Bundled Payment for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) models: a provision that removes total knee arthroplasty from the inpatient-only list beginning in January 2018. The broadening of how Medicare will […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[22],"tags":[],"class_list":["post-425","post","type-post","status-publish","format-standard","hentry","category-medicare"],"yoast_head":"\nOutpatient Arthroplasty Provision Requires Team Strategy - MedBen Analytics<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/www.medbenanalytics.com\/?p=425\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Outpatient Arthroplasty Provision Requires Team Strategy - MedBen Analytics\" \/>\n<meta property=\"og:description\" content=\"The Medicare hospital outpatient prospective payment system (OPPS) final rule includes something that will have a direct bearing on the Bundled Payment for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) models: a provision that removes total knee arthroplasty from the inpatient-only list beginning in January 2018. 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